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. 2023 Sep:260:113522.
doi: 10.1016/j.jpeds.2023.113522. Epub 2023 May 26.

Racial Disparities in Pediatric Inflammatory Bowel Disease Care: Differences in Outcomes and Health Service Utilization Between Black and White Children

Julia Smith  1 , Chunyan Liu  2 , Andrew Beck  3 , Lin Fei  4 , Cole Brokamp  4 , Syeda Meryum  1 , Kaitlin G Whaley  5 , Phillip Minar  5 , Jennifer Hellmann  5 , Lee A Denson  5 , Peter Margolis  5 , Jasbir Dhaliwal  6
Affiliations

Racial Disparities in Pediatric Inflammatory Bowel Disease Care: Differences in Outcomes and Health Service Utilization Between Black and White Children

Julia Smith et al. J Pediatr. 2023 Sep.

Abstract

Objective: To describe racial inequities in pediatric inflammatory bowel disease care and explore potential drivers.

Methods: We undertook a single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients with inflammatory bowel disease, aged <21 years, from January 2013 through 2020. Primary outcome was corticosteroid-free remission (CSFR) at 1 year. Other longitudinal outcomes included sustained CSFR, time to anti-tumor necrosis factor therapy, and evaluation of health service utilization.

Results: Among 519 children (89% White, 11% Black), 73% presented with Crohn's disease and 27% with ulcerative colitis. Disease phenotype did not differ by race. More patients from Black families had public insurance (58% vs 30%, P < .001). Black patients were less likely to achieve CSFR 1-year post diagnosis (OR: 0.52, 95% CI:0.3-0.9) and less likely to achieve sustained CSFR (OR: 0.48, 95% CI: 0.25-0.92). When adjusted by insurance type, differences by race to 1-year CSFR were no longer significant (aOR: 0.58; 95% CI: 0.33, 1.04; P = .07). Black patients were more likely to transition from remission to a worsened state, and less likely to transition to remission. We found no differences in biologic therapy utilization or surgical outcomes by race. Black patients had fewer gastroenterology clinic visits and 2-fold increased odds for emergency department visits.

Conclusions: We observed no differences by race in phenotypic presentation and medication usage. Black patients had half the odds of achieving clinical remission, but a degree of this was mediated by insurance status. Understanding the cause of such differences will require further exploration of social determinants of health.

Keywords: croh’n disease; inequities; inflammatory bowel disease; social determinants of health; ulcerative colitis.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
A directed acyclic graph developed as part of our causal inference framework. White oval associated with race and clinical outcomes; gray oval unmeasured variable.
Figure 2.
Figure 2.
The proportion of patients with IBD in sustained remission (>365 days of remission) stratified by race.
See this image and copyright information in PMC

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